Cardiovasc Prev Pharmacother.  2022 Apr;4(2):70-74. 10.36011/cpp.2022.4.e10.

Obesity and heart failure with preserved ejection fraction: pathophysiology and clinical significance

• Lee DY

• KMID: 2536923
• DOI: http://doi.org/10.36011/cpp.2022.4.e10

Abstract

Obesity is a risk factor for heart failure and cardiovascular disease. Of particular note, over 80% of patients with heart failure with a preserved ejection fraction (HFpEF) are overweight or obese. In this study, we aimed to review the association between obesity and HFpEF. Obese patients with HFpEF exhibit a distinct phenotype. In addition to impaired left ventricular (LV) diastolic function and high filling pressures, obese patients with HFpEF possess other factors that cause elevated LV filling pressure, such as a greater dependence on plasma volume expansion, aggravated pericardial restraint, and increased ventricular interaction. Obesity can contribute to HFpEF through hemodynamic, neurohormonal, inflammatory, and mechanical mechanisms. An increased amount of body fat can induce plasma volume expansion, resulting in chamber remodeling, pericardial restraint, and ultimately elevations in LV filling pressure. Obesity can mediate the activation of sympathetic nervous system signaling and the renin-angiotensin-aldosterone system. These unique pathophysiological characteristics of individuals with both obesity and HFpEF suggest that obesity with HFpEF can be considered a specific phenotype. Future research is expected to clarify effective treatment modalities for obesity-related HFpEF.

Keyword

Obesity; Heart failure; Diastolic heart failure

Figure

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  Fig. 1. Positive correlations between the left heart filling pressure and (A) body mass and (B) plasma volume in obese heart failure with preserved ejection fraction (HFpEF) but not in nonobese HFpEF. PCWP, pulmonary capillary wedge pressure. Adapted from Obokata et al. [8] with permission from Wolters Kluwer Health Inc.

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  Fig. 2. Higher proportion of individuals suffering the symptoms and signs related to heart failure (HF) despite a lower prevalence of left atrial enlargement and lower levels of N-terminal pro B-type natriuretic peptide (NT-proBNP). HFpEF, heart failure with preserved ejection fraction; NYHA, New York Heart Association. Adapted from Reddy et al. [9] with permission from Elsevier.

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  Fig. 3. Adverse effects of obesity on the cardiovascular system in heart failure with preserved ejection fraction. LV, left ventricular; RV, right ventricular; RAAS, renin-angiotensin-aldosterone system; SNS, sympathetic nervous system; NO, nitric oxide; HFpEF, heart failure with preserved ejection fraction. Adapted from Harada et al. [1] with permission from Elsevier.

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